Eric J. Topol, M.D.

Age: 55

Residence: La Jolla

Education: Bachelor of arts, with distinction, University of Virginia, 1975; MD, with honor, University of Rochester, 1979; Internal Medicine, University of California San Francisco, 1979-82; Cardiology, Johns Hopkins University, 1982-85

Career highlights: Elected to the National Academy of Sciences and the Institute of Medicine, 2004; named “Doctor of the Decade” by the Institute for Scientific Information; helped introduce several medications now in common use, including Plavix and ReoPro.

Cardiologist Eric Topol sets aside his fresh garden salad and holds up an iPhone with a palpable sense of glee.

“All I have to do is touch the screen and I can call up a patient’s vital signs, in real time,” said Topol, a renowned researcher at the Scripps Translational Science Institute in La Jolla. “See, there’s the heartbeat, pulse. You can see so much. And you can do it from wherever you are.”

Calling up vital signs is only part of what’s exciting to Topol, who doubles as co-founder of the West Wireless Health Institute. He believes that the wireless medical devices that are now coming to market cannot only save lives, but spot problems as soon as they begin to appear.

I recently discussed the future of wireless medicine with Topol, via e-mail.

QUESTION: You said not long ago that the stethoscope, which dates to 1816, probably won’t be used by doctors by 2016. You also talked about checking a patient’s vital signs by cell phone. How fast is wireless medical technology growing? And how extensive a role will it play in evaluating and monitoring human health?

ANSWER: Actually we never had a real stethoscope until now. “Steth” is the Greek word for chest and “scope” means to look in. All we have had until now are stethophones, to listen to the chest. And at least for cardiologists, listening to the heart will soon be overtaken by pocket, miniature ultrasound. This gives incredibly high-resolution videos of the heart in just a minute or two and can be part of the routine physical exam.

This technology is already here, introduced in February 2010, by GE (a device called “Vscan”). I use this for all the patients I see, at no cost except for initially purchasing the pocket echo device, and have been able to markedly reduce the number of full echoes that are needed (which cost more than $1,500, take 40 to 45 minutes, and require another appointment to be set up to get the test). Each year in the United States, over 8 million heart echoes are done at a cost of well over $10 billion. If we can cut that at least 10 (percent) to 20 percent, it has enormous potential.

As far as taking one’s vital signs, this is right around the corner. Sensors on the wrist can be used to get blood pressure, heart rate, oxygen concentration in the blood, breathing rate, temperature, and this will ultimately be displayed on the cell phone. Very exciting for people who need this, and potentially worrisome for inducing “e-hypochondriacs” for those who don’t.

The sensors will undoubtedly play an enormous role in the years ahead, since they can measure virtually anything that makes us tick, anytime, anywhere, continuously — it is just a matter of using these appropriately, validating the improvements, and making sure they can reduce the costs of health care. The overarching objective is to prevent disease — and with this technology, we will have better chances than ever before. Diabetes is a prime example. If we use continuous glucose monitoring in an individual who is at risk to help train the person what foods, what exercise, what weight, lifestyle they should have, all will promote optimal blood sugar results and help prevent the disease from ever occurring.

QUESTION: Geneticists have said that the volume of information they’re getting is overwhelming. Will these emerging wireless medical devices produce more information than a physician can absorb and use?

ANSWER: There are remarkable parallels of genetics and wireless, both forms of digital medicine. Both generate a deluge of data and require filtering, processing to get the distillate or “juice” of the important information. That is the stuff that is relayed to the physician and if it is done properly, it should not be a burden to keep up with the patient’s monitoring.

The same issues of data security and privacy also apply to both types of digital medicine. At Scripps, we are fortunate to be funded through the NIH CTSA grant to work on these important challenges in genomics and wireless medicine to accelerate research to improve human health. For example, we work with the San Diego Supercomputer Center, one of only four such facilities in the United States, to help manage the enormous data we generate in genomic medicine.

QUESTION: You’ve talked about devices that measure caloric intake. I understand the medical value of this. But is there a danger that employers and insurance companies will gain access to such data and use it to decide whether a person should keep a job or receive medical benefits?

ANSWER: The caloric intake sensor is an important goal to help manage and ideally prevent diabetes, heart disease, and a number of other conditions. It isn’t ready yet, but several groups are working on this Band-Aid type device. Like with genomics, there is the potential for misuse of data (as noted above) and we have a law called GINA — Genetics Information Non-Discrimination Act — to protect against any potential misuse. We may ultimately need similar legislation for wireless devices.

QUESTION: Let’s take the doctor out of the picture for a moment. How will individuals use these devices?

ANSWER: It depends a bit on the device. For blood pressure, individuals will be able to track their data and notify their physician if their medications are not doing the job. What is different is having all the data throughout the night, at times of anxiety or particular stress, and continuously sending the data we were never able to acquire or know before. And it is seamless, not taking any effort. The same principle applies to blood glucose, oxygen saturation in the blood (to diagnose sleep apnea, a breathing disorder that is relatively common), and so many other metrics. Individuals will be able to see their data and be much more involved in managing their condition, or preventing it. Some devices, such as one that captures all the heart rhythm, will require physician oversight, since we are not anticipating consumers to learn how to read EKGs.

QUESTION: Department store doors that opened automatically were introduced when I was a very young. It seemed like, well, magic. What wireless medical devices will we have in just a few years that will seem, well, magical?

ANSWER: It does seem magical now, but just like your analogy, several years from now the “magic” will be taken for granted. Devices to monitor heart rhythm, heart failure, blood sugar, blood pressure, asthma, breast cancer, mood and so many others are “in the hopper.” This is the most exciting and extraordinary time of medicine in history whereby engineering, bioinformatics — along with the broadband Internet, pervasive connectivity, smart phones, ingenious noninvasive sensors — to address so many unmet, vital medical needs. Each potential solution will have to be validated which will take time but this represents a critical step along the way.

QUESTION: Mood? Science is going to be able to monitor mood? How would you be able to tell whether a person was simply having a bad day or suffering from serious depression? Will there be medical devices for that?

ANSWER: Yes, they are already being pursued. It is remarkable how well mood can be quantified and tracked by following speech, tone of voice, activity, position, extent of communication via e-mail, texting and phone. We’ll see our mood index continuously displayed on our smart phones in the not so distant future (if you want to). And our colleagues and co-workers may get tipped off too, if they’re plugged in.

QUESTION: What aspects of your own health do you monitor, and are there any areas you simply do not want to look at because they reflect something you ultimately cannot control — aging?

ANSWER: I have had genome-wide scanning, so I know I should be careful about coffee and caffeine since I am a slow metabolizer and chronic intake of high quantities would put me at risk of a heart attack. I know about my risk of Alzheimer’s disease and my lifestyle of frequent rigorous exercise and a very healthy diet takes the knowledge of this and other genomic risks that I carry into account. I have used wireless sleep monitoring to improve my sleep and I am soon going to start measuring my glucose continuously (every 5 minutes) for a couple of weeks using a wireless sensor device. Then I’ll know how to apply this in patients at risk of developing diabetes.